深圳地区羊水过少226例临床分析

目的探讨羊水过少与妊娠并发症的关系及其分娩方式的选择与围生儿预后关系。方法收集我院2005年6月至2006年5月住院分娩的羊水过少孕妇226例,随机抽取我院同期分娩的羊水量正常孕妇220例为对照组,两组病例就妊娠并发症、分娩方式及围生儿情况进行比较。结果羊水过少组中过期妊娠、妊娠期高血压疾病、胎儿生长受限（FGR）及胎儿畸形的发生率均高于对照组（P〈0.01）。羊水过少组羊水粪染、胎儿窘迫、胎粪吸入综合征（MAS）的发生率明显高于对照组（P〈0.05,P〈0.01）。羊水过少伴妊娠并发症组羊水粪染、胎儿窘迫、新生儿窒息的发生率明显高于无并发症组,（P〈0.01,P〈0.05）,剖宫产率明显增加（P〈0.01）,而胎粪吸入综合征（MAS）与围生儿死亡率无显著差异（P〉0.05）。单纯羊水过少者围生儿结局与对照组无显著差异（P〉0.05）。结论羊水过少与妊娠并发症密切相关,羊水过少伴有妊娠并发症者围生儿结局不良,应放宽手术指征,单纯羊水过少者可以阴道试产。     

妊娠足月羊水过少及羊水偏少对围生结局影响

目的对比研究妊娠足月羊水过少和羊水偏少的分娩及围生儿结局。方法回顾性分析2008年5月-2011年5月我院妊娠足月48例羊水过少、57例羊水偏少孕妇,并随机抽取同期B超检查羊水量正常、无明显高危因素经阴道试产的足月孕妇50例作为对照组,比较三组的分娩方式和围生儿结局。结果羊水过少组急诊剖宫产率显著高于羊水偏少及对照组(P0.01),但羊水偏少组急诊剖宫产率与对照组比较无显著差异(P0.05);羊水过少组中胎儿窘迫、羊水污染、新生儿窒息率均高于对照组(P0.05)及羊水偏少组,但羊水偏少组与对照组比较无显著差异(P0.05)。结论羊水过少对围产儿的影响大,须加强监护,选择适时合理的分娩方式终止妊娠;羊水偏少孕妇应动态监测羊水变化,可在严密监护下行阴道试产。     

围生期羊水过少对母儿的危害

目的 探讨囤生期羊水过少对母儿的影响.方法 利用B超羊水指数法和直接测量估测羊水量及测定脐动脉收缩期最大血流速度(S)和舒张末期血流速度(D)的比值(S/D),并进行胎儿无应激试验(NST)监护,比较分析羊水过少组(观察组)和羊水正常组(对照组)的妊娠并发症、分娩方式、羊水混浊及羊水量、羊水混浊与胎儿缺氧关系、围产儿情况等.结果 观察组的妊娠期高血压疾病、过期妊娠、胎儿生长受限、胎儿畸形等妊娠并发症发生率均明显高于对照组(P均<0.01);观察组的胎儿宫内窘迫、新生儿窒息、吸入性肺炎的发生率均明显高于对照组(P均<0.05);观察组的剖宫产率和羊水混浊发生率均明显高于对照组(P均<0.01);观察组的羊水量愈少,羊水混浊程度愈严重,胎儿窘迫及新生儿窒息发生率愈高.结论 围生期羊水过少.对母儿的危害很大可使妊娠并发症和胎儿窘迫、新生儿窒息、吸入性肺炎的发生率明显升高.故加强对羊水过少的产前监护是非常重要的,剖宫产是重度羊水过少孕妇分娩方式的最佳选择.     

脐带先露及脐带脱垂65例临床分析

目的探讨脐带先露及脐带脱垂与围生儿结局的关系。方法回顾性分析65例脐带先露及脐带脱垂的临床资料。结果脐带先露组剖宫产占80.49%（33/41）,显著高于脐带脱垂组的54.17%（13/24）（P〈0.05）。新生儿1minApgar评分脐带先露组与脐带脱垂组存在极显著差异（P〈0.001）,新生儿5min Apgar评分两组亦存在显著差异（P〈0.05）。脐带先露组围生儿死亡率2.44%（1/41）,明显低于脐带脱垂组20.83%（5/24）（P〈0.05）。结论围生儿结局脐带先露组明显优于脐带脱垂组,早期诊断和干预脐带先露,防止脐带脱垂的发生,对改善围生儿结局有重要的作用。     

B超诊断羊水过少328例临床分析

目的探讨晚期妊娠羊水过少对围产儿的影响,以提高产科医疗质量。方法比较分析晚期妊娠羊水过少328病例与同期羊水量正常的产科病例的妊娠期并发症、围产儿结局及分娩方式。结论羊水过少是阴道分娩过程中发生胎儿窘迫、新生儿窒息的危险因素,剖宫产术是晚期妊娠羊水过少比较安全的分娩方式。     

羊水过少对围产儿的影响及与妊娠并发症的关系81例分析

目的探讨羊水过少对围产儿的影响及与妊娠并发症的关系。方法分析我院2003年7月至2006年7月住院分娩的羊水过少孕妇81例。并随机抽取81例无羊水过少孕妇做对照组。就两组的围产儿结局及与妊娠并发症的关系做对比分析。结果羊水过少组妊娠并发症发生率较对照组高。胎儿宫内窘迫,羊水粪染,新生儿窒息发生率也明显高于对照组(P<0.01)。结论羊水过少严重威胁着围产儿的生命,且与妊娠并发症关系密切,可做为许多妊娠并发症及围产儿不良结局的危险信号。     

75例羊水过少孕妇临床围产情况分析

目的分析妊娠期羊水过少与其他妊娠并发症的关系,探讨其对围产儿的影响。方法分析75例羊水过少孕妇和90例各项指标正常孕妇（设为对照组）的相关情况,比较两组妊娠并发症、分娩方式以及围产儿情况。结果羊水过少组各种妊娠并发症均明显高于正常对照组（P〈0.05）。结论羊水过少相关因素较为复杂,是对妊娠不利的高危因素,产科工作者要注重加强围产保键,定期做产前检查,积极采取干预措施,减少对围产儿的不利影响,降低孕妇风险提高围产儿成活率。     

250例畸形子宫妊娠结局分析

目的了解畸形子宫对母儿妊娠结局的影响。方法对我院2002年1月至2012年1月10年间收治的250例畸形子宫合并妊娠进行回顾性分析,随机抽取我院同期分娩的子宫正常孕妇200例为对照组,两组病例就分娩方式、妊娠期并发症及围生儿情况进行比较,探讨畸形子宫对母儿妊娠结局的影响。结果畸形子宫组中早产、胎位异常、胎膜早破、脐带缠绕,胎盘粘连发生率高于对照组（P〈0．01,P〈0．05）,剖宫产率高于对照组（P〈0．01）,但新生儿窒息率,围生儿死亡率及产后出血无显著差异（P〉0．05）。结论畸形子宫妊娠期及分娩期并发症增加,应加强产前检查,产时监护,适时终止妊娠减少母儿不良妊娠结局。     

IL-6、MMP-9、TNF-α在胎膜早破早产孕妇血清、羊水中的表达及意义

目的研究IL-6、MMP-9、TNF-α在未足月胎膜早破早产孕妇的血清、羊水中的含量及表达,探讨其与胎膜早破早产的关系。方法采用酶联免疫吸附法检测30例胎膜早破早产孕妇（PPROM组）与20例正常孕妇（对照组）血清和羊水中的IL-6、MMP-9、TNF-α的含量,同时进行胎膜的病理检查。结果 PPROM组母血清及羊水中IL-6、MMP-9的含量均高于对照（P〈0.05）,羊水中TNF-α的含量较对照组高（P〈0.05）。PPROM组绒毛膜羊膜炎者血清、羊水中IL-6、TNF-α（P〈0.05）、MMP-9（P〈0.01）水平均高于非绒毛膜羊膜炎者。结论孕妇血清、羊水中IL-6、MMP-9、TNF-α水平与PPROM感染引起的早产有关,检测其水平可作为PPROM良好的预测指标。     

羊水过少对围产儿的影响及分娩方式选择浅析

目的研究羊水过少对围产儿的影响及分娩方式的选择.方法收治羊水过少102例,与随机抽取同期分娩102例羊水量正常病例,就妊娠并发症、围产儿情况、分娩方式进行比较.结果羊水过少组合并妊高征、过期妊娠、IUGR明显增高,合并羊水Ⅲ*浊、胎儿宫内窘迫明显高于羊水量正常组,剖宫产机会也明显增高[1].结论应用B超诊断,羊水过少合并妊高征、过期妊娠、IUGR以计划剖宫产为宜,对降低围产儿死亡率有重要意义.     

Maternal serum procalcitonin levels in prediction of chorioamnionitis in women with preterm premature rupture of membranes

IntroductionChorioamnionitis is one of the most important maternal complications in the expectant management of patients with preterm premature rupture of membranes (PPROM). Procalcitonin (proCT), the precursor of the hormone calcitonin, is used to differentiate bacterial infections from non-bacterial ones. The objective of the study was to determine the efficacy of maternal serum procalcitonin levels in the early prediction of chorioamnionitis in women with PPROM.Material and methodsThe study was conducted in 76 pregnant women hospitalized due to PPROM at the maternal-fetal medicine unit of a tertiary center in Istanbul. Patients were followed up with white blood cell (WBC), C-reactive protein (CRP) and proCT levels every 2 days. The values of investigated parameters were recorded at the diagnosis of PPROM and at the time of delivery. The maximum values during the follow-up period were also recorded.ResultsOut of the 76 patients with PPROM, 15 (19.73%) developed clinical chorioamnionitis. No significant difference could be detected in the gravidity, parity, duration of hospitalization and gestational week at diagnosis between those patients who developed clinical chorioamnionitis and those who did not. The WBC at the time of hospital admittance and before delivery, and CRP levels before delivery were statistically higher in the chorioamnionitis group (p < 0.05). No difference in the proCT levels could be detected either at the time of hospital admittance or before delivery between the two groups.ConclusionsMaternal proCT was not found to be predictive of chorioamnionitis. However, since there are reports in the literature that contradict these results, further studies are warranted to determine the true efficacy of proCT in the prediction of clinical chorioamnionitis.     

Prolidase,Matrix Metalloproteinases 1 and 13 Activity,Oxidative-Antioxidative Status as a Marker of Preterm Premature Rupture of Membranes and Chorioamnionitis in Maternal Vaginal Washing Fluids

Objective: Etiology of premature preterm rupture of membranes (PPROM) is not yet completely known and chorioamnionitis is one of the most important complications of its. We aimed to evaluate whether prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in vaginal washing fluid (VWF) were associated with etiology of PPROM and whether these markers could be used to predict chorioamnionitis in PPROM.Study Design: This prospective case control study enrolled fifty pregnant women with PPROM and 50 healthy pregnant women. The VWF samples were taken at the time of admission in the PPROM group and patients were followed for chorioamnionitis. Prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in VWF were assayed.Results: VWF levels of prolidase, matrix metalloproteinases 1-13 (p< 0.001), oxidative stress parameters, total oxidative stress (TOS) (p < 0.001) and oxidative stress index (OSI) (p = 0.002), and hs-CRP (p = 0.045) were significantly higher in the PPROM group than in the controls. Antioxidative status parameters, levels of paroxanase (PON-1) (p < 0.001) and total antioxidant capacity (TAC) (p < 0.001), were significantly lower in the PPROM group than in the controls. Mean VWF levels of prolidase (p < 0.001), metalloproteinases (p<0.05), and oxidative-antioxidative status parameters (p<0.05) were significantly different in women with versus women without chorioamnionitis in the PPROM group. Prolidase, MMP-13, TOS, TAC, and PON-1 were found as important predictors for chorioamnionitis in the PPROM group by the multivariate logistic regression analysis. When the ROC curve analysis for prolidase, MMP-13, TOS, TAC, and PON-1 were performed, all of them were statistically significant for area under the curve (areas under the curve were 0.94, 0.90, 0.80, 0.25, and 0.19, respectively).Conclusions: This study showed that collagen turnover mediators, especially prolidase, and increased oxidative stress are significantly associated with PPROM. Also, chorioamnionitis can be predicted with prolidase, MMP-13, TOS, TAC, and PON-1 in PPROM patients.     

妊娠期糖尿病患者脐血促红细胞生成素含量及其与胎儿缺氧的相关性研究

目的通过测定妊娠期糖尿病(GDM)患者与正常妊娠孕妇脐血促红细胞生成素(EPO)的浓度和脐血血气分析,探讨GDM患者的脐血EPO水平与其胎儿慢性缺氧的相关性,以期为临床找到一种反映GDM所致的胎儿慢性缺氧及预测后遗症的理想指标。方法应用酶联免疫吸附试验测定法(ELISA)对30例GDM患者(实验组)及30例正常妊娠孕妇(对照组)的剖宫产儿的脐静脉血清EPO进行定量检测,同时进行脐静脉血气分析。应用独立样本t检验,所有的实测值均采用x±s表示。由于脐血EPO与血气分析之间可能存在一定关系,故行单因素相关分析,并行相关系数的显著性检验,所有分析均在SPSS 11.5软件包上完成。结果①实验组的脐静脉血EPO浓度,比对照组相应的EPO浓度明显升高,P<0.01;②脐血EPO值与脐血PCO2呈正相关,P<0.01;与BE值呈负相关,P<0.01;与pH值、PO2无相关性,P>0.05。结论 GDM患者脐血EPO水平明显升高,与胎儿宫内慢性缺氧程度有密切关系。预测胎儿慢性缺氧,检测脐血或羊水中EPO的价值可能优于脐血血气分析。     

羊水过少对不良围产期结局的影响及其治疗

目的 探讨羊水过少对不良围产期结局的影响及其治疗。方法 对羊水过少104例临床资料进行分析。结果 羊水过少组胎儿生长受限、妊娠高血压疾病、妊娠期肝内胆汁淤积症的发生率较对照组明显增高，差异有显著性（P〈0．01）。延期妊娠、胎儿畸形发生率较对照组增高（P〈0．05）；胎儿宫内窘迫、羊水粪染、剖宫产率明显增高（P〈0．01），新生儿窒息的发生率增高（P〈0．05）。结论 羊水过少可造成不良围产结局，一经确诊应积极处理。     

基质金属蛋白酶-9、白介素-1β与未足月胎膜早破的关系

目的探讨基质金属蛋白酶-9（MMP-9）、白细胞介素-1β（IL-1β）与未足月胎膜早破（PPROM）及绒毛膜羊膜炎的关系。方法采用双抗体夹心酶联免疫吸附法检测未足月胎膜早破组56例、足月胎膜早破组38例、正常妊娠组30例孕妇的血清、羊水、脐血中MMP-9、IL-1β的水平,并进行胎膜的病理检查。结果胎膜早破孕妇的血清、羊水、脐血中MMP-9、IL-1β水平明显高于对照组,而且未足月胎膜早破孕妇的MMP-9、IL-1β水平亦高于足月胎膜早破者（P〈0.01）;未足月胎膜早破组的绒毛膜羊膜炎的发生率明显高于足月胎膜早破组（P〈0.01）;发生绒毛膜羊膜炎的胎膜早破孕妇的血清、羊水、脐血中MMP-9、IL-1β水平明显高于非绒毛膜羊膜炎的胎膜早破孕妇（P〈0.01）。结论检测孕妇血清的MMP-9、IL-1β水平可作为未足月胎膜早破良好的预测指标,测定孕妇血清、羊水的MMP-9、IL-1β水平还有助于胎膜早破并绒毛膜羊膜炎的早期诊断。     

七氟醚联合瑞芬太尼用于产科全身麻醉对 炎性细胞因子的影响

目的 研究七氟醚联合瑞芬太尼用于产科全身麻醉对炎性细胞因子的影响。方法 选取2018年3月~2019年3月我院收治的行产科全身麻醉足月产妇120例,随机分为对照组和观察组,各60例。对照组采用瑞芬太尼麻醉,观察组在对照组基础伤联合七氟醚,比较两组麻醉诱导前、气管插管后、胎儿娩出后、拔管后各时间段炎性细胞因子（IL-6、TNF-α、sTNFR-Ⅱ）水平、动脉压（MAP）、心率（HR）、新生儿Apgar 评分、脐动脉pH以及术中情况。结果 两组气管插管后、胎儿娩出后IL-6、TNF-α、sTNFR-Ⅱ水平均高于麻醉诱导,拔管后IL-6、TNF-α、sTNFR-Ⅱ水平均低于麻醉诱导前,且各时间段观察组低于对照组,差异有统计学意义（P＜0.05）;两组气管插管后、胎儿娩出后MAP、HR均低于麻醉诱导前,拔管后HR均高于麻醉诱导前,且各时间段观察组高于对照组,差异有统计学意义（P＜0.05）;观察组新生儿Apgar 评分、脐动脉pH值以及术中情况与对照组对比,差异无统计学意义（P＞0.05）。结论 七氟醚联合瑞芬太尼用于产科全身麻醉安全有效,可减少炎性因子的释放,进而稳定血压和心率,对提高手术安全性具有重要的意义。     

Interleukin-6 as a predictor of subclinical chorioamnionitis in preterm premature rupture of membranes

Citation Gulati S, Bhatnagar S, Raghunandan C, Bhattacharjee J. Interleukin‐6 as a predictor of subclinical chorioamnionitis in preterm premature rupture of membranes. Am J Reprod Immunol 2012; 67: 235–240 Problem One of the major challenges faced by the clinicians in preterm premature rupture of the membranes (PPROM) is to correctly identify when a significant chorioamnionitis is evolving and decide timely delivery of the fetus. Measuring interleukin‐6 levels in maternal serum can be useful for the identification of asymptomatic intrauterine infections in subjects with PPROM. Method of study A total of 75 pregnant women, of which 45 pregnant women presenting with PPROM between 24 and 34 weeks gestation and 30 healthy pregnant women without PPROM, were included in the study. Serum IL‐6 levels were determined by solid‐phase sandwich enzyme‐linked immunosorbent assay (Diaclone Research, Besancon, France). Results The mean serum IL‐6 value at admission in the control group was 2.48 ± 2.7 pg/mL and in the study group was 11.86 ± 14.5 pg/mL (P = 0.001). Mean serum IL‐6 concentrations at admission in subjects without histological chorioamnionitis were 3.98 ± 3.9 pg/mL and in those who had histological chorioamnionitis were 20.09 ± 16.8 pg/ml (P < 0.001). Conclusion Maternal serum IL‐6 levels were significantly elevated in subjects with PPROM with infectious morbidity as compared to those without infectious morbidity in the present study. There was a significant rise in maternal serum IL‐6 levels with increased duration of rupture of membranes and with evidence of histological chorioamnionitis and funisitis in the placenta.     

脐带绕颈对围生儿及分娩方式的影响

目的探讨脐带绕颈对围生儿及分娩方式的影响。方法回顾性分析80例脐带绕颈病例的临床资料，并与80例无脐带绕颈者进行对照研究，比较两组出现胎儿窘迫、新生儿窒息等情况和分娩方式的不同。结果脐带绕颈组胎儿窘迫、新生儿窒息和助产率均高于对照组，两组剖宫产率无明显差异。结论脐带绕颈对围生儿有不良影响，使阴道助产率增高，而不增加剖宫产危险。加强产前诊断和产时监护，选择最佳方式及时机分娩是降低围生儿死亡率及新生儿窒息率的有效措施。     

外柱细胞软化对Corti器感音影响的生物力学研究

Corti器的感音过程容易受到内部结构属性变化的影响。外柱细胞血管舒张刺激磷蛋白缺失会减缓肌动蛋白丝的形成,从而产生听力延迟。本研究运用COMSOL建立三维有限元模型研究肌动蛋白缺失导致外柱细胞软化时,Corti器感音过程中基底膜和外毛细胞与Deiters细胞结合点的力学行为变化。结果表明,外柱细胞软化会削弱外毛细胞主动力对基底膜位移增益的放大作用,但削弱作用并不会立即产生,Corti器存在维持正常功能的“缓冲”阶段。在100 dB和120 dB之间可能存在一个声压级临界值,在该临界值两侧外柱细胞软化对基底膜应力变化的影响是截然相反的。另外外柱细胞软化对不同外毛细胞与Deiters细胞结合点力学行为的影响也不同,位移增益优先级会因此产生改变。